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Preface

If you are reading this preface you are unusual. Most readers do
not read prefaces. If you are reading it purposefully, you probably
want to know why you should buy or read this book, what it
contains, or why it has been put together in the way it has. So we
will try to answer those questions.

This book is designed as a medium-sized reference providing
up-to-date, evidence-based information on the management of the
major problems in gastrointestinal oncology, both surgical and
medical. It gives in-depth coverage of important current issues and
controversies and clarifies the nature and quality of the evidence.
It does not provide information on exotic rarities or
superspecialist debates. It is designed for a busy clinician who
needs practical support in dealing with the problems of oncological
practice. It has a deliberately international authorship so that
readers can appreciate both the commonalities in the approach to
cancer treatment throughout the world as well as some of the
interesting debates and differences.

It is to be hoped that it is no longer necessary to justify
taking an evidence-based approach. In the decade since the
evidence-based movement became internationally popular, there has
been an enormous improvement in the general quality of the
reporting of clinical research, largely stimulated by the pressure
from clinical epidemiologists, who have pointed out the flaws and
pitfalls of traditional reporting and study methods. We all now
recognize that it is vital to evaluate the quality of the evidence
on which our clinical practice and beliefs are based and to retain
a healthy degree of doubt where the lack of good objective evidence
calls for it. We asked our contributors to answer specific
questions current in their field and to grade the supporting
evidence for their answers according to an internationally accepted
classification. We hope this will allow the reader to gain a much
clearer perception of the scope of current knowledge than may be
gained from reading the declarative statements in traditional
textbooks, many of which would fail to stand up the scrutiny of an
evidence-based examination. A pure summary of the evidence, without
any significant expert commentary would, however, be unhelpful, as
well as extremely dull. One of the things we are now quite clear
about is the extent to which our knowledge of the efficacy of
treatment is imperfect and incomplete. A simple account of the
evidence would therefore leave many holes, gaps, and questions,
unplugged and unanswered. Both the senior trainee and the
practicing clinician need guidance in situations where the evidence
is not sufficiently strong to provide an immediate answer, and help
in interpreting the finer points of controversies and debate where
the evidence is conflicting. We have therefore asked experts in
each field to provide an account that mixes their own experience
and broad understanding of the subject with a rigorous analysis of
the available clinical trials.

We hope this book will appeal to a wide audience. We think it
should be useful to senior trainees in gastrointestinal surgery,
surgical oncology, clinical oncology, and gastroenterology. We have
principally aimed it at practicing clinicians, who need an
authoritative update on topics within their practice, but lack the
time or resources to conduct an exhaustive review of the evidence
themselves. We hope that patients and their relatives with a desire
to understand the detailed arguments and evidence behind proposed
treatments will also gain from reading the relevant chapters.

The controversies and hot topics discussed in the book include
the surgical approaches to multiple liver metastases and hepatoma,
to esophageal, gastric, and rectal cancers, as well as the
oncological evidence on adjuvant and neoadjuvant therapy for these
tumors and for the pancreas. We also have excellent advice on the
management of malignant and premalignant disease in Barrett's
esophagus and a comprehensive monograph on the management of
carcinoid tumors of the GI tract. We have been fortunate in that
this elite group of contributors have agreed to help us with this
volume. While we emphasize the importance of the objective
evidence, many readers will be particularly interested to also read
the opinions of internationally recognized authorities such as Glyn
Jamieson, Yuman Fong, Masatoshi Makuuchi and Hubert Stein on the
surgical side, and Michel Ducreux, Joel Tepper, Eric Van Cutsem and
Carol Portlock among oncologists. We express our sincere thanks to
all our chapter authors for their hard work and for cooperating
with us in working in an unfamiliar format.

We hope you do find this book useful and are very happy to
receive feedback on how it can be improved.